Please complete the form as accurately as possible, giving as much detail as you can.

INTRODUCER DETAILS
Your Name: Your Email:
Company Name: Address:
Your Telephone: Your Fax:

If you want to make any comments regarding this case, please use the box below:

THE  LOAN
Type of Loan Required:
Loan amount required:
Loan Term (months):
Purpose of loan:
 
PERSONAL DETAILS
Status:
Title:
First name(s):
Surname:
Email Address:
Date of birth:
Partner's Title:
Partner's first name(s):
Surname:
Date of birth:
Your address:



Post Code:
Time at this address (Years):
Telephone (including STD):
Telephone - Work
Mobile Phone :
Previous address if you have lived for less than three years at your current address
 



Post Code:
   
YOUR WORK
(Note: if you are self-employed please state occupation and how long trading.)
Employer's name:
Employers address:



Postcode:
Time employed by them (Years):
Job Description:
Occupation Type:
Partner's employer's name:
Partner's employer's address:



Postcode:
Partner's Job Description:
Partner's Occupation Type:
Time employed by them (Years):
   
ABOUT YOUR HOME
Total monthly mortgage payment:
Approximate amount outstanding:
Total arrears (if any):
Highest arrears in the last 12 months (if any)
 
Original amount borrowed on mortgage (including all further advances)
 
The name of the company you have your mortgage with
 
The name of the Bank or Building Society you use
Name:
Account open (Years):
Current Account No:
Sort Code:
Year your home bought:
What is it worth now?
The amount you paid for your home
 
Is it owned/rented:
   
YOUR INCOME
Your gross income with overtime and any bonuses (if self-employed your net income).
Gross:
Per:
Your partner's gross income with overtime etc.
Gross:
Per:
If self-employed can you supply accounts?
  Yes No
I/We authorise that you or any lender to whom you submit this application, may use and disclose clients data as described in the pages entitled "Data Protection" and that these pages have been read and understood.

 

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